What factors and influences facilitate transformative learning in the Southeast Consultant Practitioner Development Programme?

Abstract

Introduction: The Global healthcare burden is rising due to increased clinical complexity, healthcare globalisation, and a growing workforce shortage across the medical profession. This poses a threat to the quality, impact, and sustainability of healthcare systems requiring a move toward a biopsychosocial approach to meet population demand. There is therefore a need to develop transformational systems leadership across nursing, midwifery, and the allied health professions. However, there are currently no clear definitions of consultant (expert level) practitioners, such as the purpose of the role, optimal accredited learning, and development pathways or where to place them in the healthcare system. These practitioners are beyond a technical expert with a requirement to demonstrate clinical expertise in practice across all domains of expert level practice capabilities, however, these too are yet to be defined. This challenges the quality, impact, and sustainability of these roles. Aim and objectives: To explore the learning effectiveness of the Southeast Consultant Practitioner Development Programme (SECDP) using Mezirow’s transformative learning theory as an underpinning educational theory to create transformational systems leadership. Objectives: a) public and patient involvement at the design phase of research to inform and direct the thesis; b) historical narrative to explore the evolution of the Southeast Consultant Practitioner Development Programme (formerly Wessex Consultant Practitioner Development Programme) from its conception to the present date to understand the facilitators and challenges encountered in creating and enacting the development of aspirant consultant practitioners to consultant level practice; c) mapping exercise against the Multi-Professional Consultant Capability and Impact Framework to check alignment; d) international scoping review to explore definitions of, and the learning and development pathways leading to, expert practice across nursing, midwifery, and Allied Health Professions ( AHPs )internationally; and e) programme alumni and programme leads: to explore the experience of the alumni’s journey through the Southeast Consultant Practitioner Development Programme through the lens of transformative change in relation to disorientating dilemma, critical reflection, and communicative discourse. Methods: Qualitative and tabletop methods were undertaken and triangulated within an explanatory single case embedded case study methodology to gain multi-dimensional knowledge through credible explanations. Five papers were completed iteratively for publication and peer review. Data analysis: Data synthesis included: Critical Appraisal Skills Programme (CASP) and GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) for quality interrogation, curriculum mapping, content analysis, and 3 and 7 stage thematic analysis informed by Thomas and Harden. Results: 1) public and patient involvement: challenged and changed thesis methodology, identified main themes to be addressed for an international scoping review; 2) international scoping review: n=16,695 papers were identified, n=8596 were reviewed by title and abstract, and n= 176 full text reviews were completed. Twenty-two studies were included which identified and synthesised definitions of expert practice, learning and development pathways, accreditation, regulation, and revalidation. It was noted that there was a lack of an underpinning educational learning theory in postgraduate education at this level of practice. Two conceptual models were developed using thematic analysis; components required for sustainable learning and development pathways to expert level practice and an optimal accredited learning and development process at this level of practice; 3) historical narrative: identified challenges and facilitators of programme development and implementation of expert level practice. 4) curriculum mapping shows the Southeast Consultant Practitioner Development Programme maps implicitly to the United Kingdom (UK) multi-professional consultant capability and impact framework. Minor amendments are needed to make the implicit explicit. 5) alumni and programme lead research: seven key categories and outcomes fundamental to the transformative learning process were identified in addition to definitions of an interrelated dynamic support network. Further data synthesis enabled the development of two conceptual models: a) three-year confidence cycle linked to a dynamic support network to develop the realisation of potential through transformative learning in practice; and b) an extension to the transformative learning framework demonstrating how it can work in practice. 6) across papers: 11 common factors and influences aiding development, facilitation and implementation of transformative learning interrelated to a support network at expert level practice were identified. Identity was seen as key across all factors and influences, and the dynamic support network central to support the process of developing personal and professional identity. Summary: This thesis has generated new knowledge which includes: the identification of common definitions of expert level practice, components required for sustainable learning and development of transformational leadership including a dynamic support network (DSN); 11 common factors and influences that facilitate transformative learning in practice; a conceptual accredited model of optimal learning and development to consultant level practice; a conceptual confidence cycle linking attainment of potential to engage in transformative learning with an interrelationship of a DSN across 3 years; and a conceptual extension to Mezirow’s transformative learning theory framework in practice. Fundamental to the development and sustainability of these roles is the need for clear personal and professional identity (definitions). Without these, there cannot be development of optimal learning and development pathways, career pathways or effective placement of consultant practitioners or systems transformation within the healthcare system to meet population demand. Further studies are required to agree on standardised definitions, and to test the conceptual models for proof of concept.